From OncoLog, June 2006, Vol. 51, No. 6

Breast Cancer in the Prime of Life

by Karen Stuyck

Usually associated with women over 45 years old, the appearance of breast cancer is unexpected in young women and often overlooked by patients and their doctors. Since screening mammography is usually not recommended until age 40 and nonmalignant breast problems such as fibroadenomas and cysts are quite common in younger women, “it takes a while for people to believe this could be cancer,” said Karin Hahn, M.D., an assistant professor in the Department of Breast Medical Oncology at The University of Texas M. D. Anderson Cancer Center.

Women might think they have a cyst related to their menstrual cycle rather than breast cancer, and the physician might suggest follow-up rather than diagnostic testing. As a result of this delay, coupled with the frequent aggressiveness of the disease in young women, when a diagnosis of breast cancer is finally made, it is often a later-stage breast cancer, Dr. Hahn said. In these cases, the cancer is more likely to have spread to the lymph nodes and to be a larger mass when diagnosed.

“Younger women and their physicians should be aware that about 13% of women diagnosed with invasive breast cancer are under the age of 45,” said Dr. Hahn. A breast mass that persists more than 6 weeks should be investigated radiographically by mammography and/or ultrasonography and biopsied if imaging does not show an apparently benign lesion, Dr. Hahn said. Each year, more than 28,000 women in the United States under the age of 45 are diagnosed with breast cancer, including many who do not have a family history of the disease. Approximately 150 of them receive care at M. D. Anderson each year.

Different challenges

Breast tumors in younger women are often a higher nuclear or histologic grade than tumors in postmenopausal women, according to Dr. Hahn. “These tumors look much more aggressive under the microscope and are more likely to be estrogen insensitive when compared with the tumors of postmenopausal women, which means antiestrogen treatments such as tamoxifen probably won’t be helpful,” she said. Women with estrogen-insensitive tumors are left with systemic treatment options such as chemotherapy, plus a biological agent such as Herceptin if they have a HER2/neu-positive tumor. “We know that even in premenopausal women, the antiestrogen therapies do decrease the risk of recurrence, but if the tumor isn’t estrogen sensitive, the patient loses that opportunity.”

Younger women with breast cancer also often experience different side effects of treatment than their older counterparts. “Young women with breast cancer face different challenges than postmenopausal patients, such as infertility, increased bone loss, premature menopause, and a higher rate of fatigue,” said Dr. Hahn, who directs M. D. Anderson’s Breast Survivorship Clinic and oversees the Beth Sanders Moore Young Breast Cancer Survivors Program.

Treatment for breast cancer may cause young women to undergo premature menopause, experiencing attendant hot flashes, psychological discomfort, sleep disturbances, and loss of bone mass. More than 50% of breast cancer patients under age 40 will recover ovarian function after treatment, but after age 40, their chances decrease, Dr. Hahn said.

Bone loss is a big problem for young women with breast cancer. Dr. Hahn cited a recent study in the Journal of Clinical Oncology reporting that premenopausal women taking tamoxifen for estrogen-sensitive breast cancer can actually lose bone mass. Therefore, it is important for these women to receive bone density testing. Breast cancer survivors who experience premature menopause after treatment also should be monitored for bone loss because they are at a much increased risk of developing osteoporosis, said Dr. Hahn.

Any woman under the age of 40 who is diagnosed with breast cancer should be offered genetic counseling and testing for mutation of the BRCA1 and BRCA2 genes, which increases the risk of recurrent breast cancer. Mutation of the BRCA1 gene could also indicate an increased risk of ovarian cancer. “This information can help a woman consider such questions as whether or not she should have a bilateral mastectomy and whether she might choose to have a prophylactic oophorectomy,” said Dr. Hahn.

Psychological needs

Younger women with breast cancer often have different psychological needs than older women with the disease, according to Anita Broxson, a research nurse in M. D. Anderson’s Department of Breast Medical Oncology and the program director for the Beth Sanders Moore Young Breast Cancer Survivors Program. These young women feel very alone, Ms. Broxson said, relating the story of a young woman with a one-year-old child who attended a support group for breast cancer patients. Everyone in the group was much older than she, and while they were welcoming to her, the woman felt she had “nothing in common with what they were going through.” As a result, she never went back to the support group.

Breast cancer, Ms. Broxson said, “is an interruption of the usual life stages.” Often, young patients have considered themselves healthy their whole lives. They might have young children or were planning to have children. Breast cancer throws a wrench into their life plans.

These women appear to have a more intense fear of their cancer recurring than older breast cancer patients do, Ms. Broxson said. They wonder if they will be alive to see their children grow up or whether they will have enough stamina to raise them. They also often worry about how to tell their young children about their illness and how to communicate to their family how they are feeling and the adjustments that must be made.

Helping them to cope with their anxiety, learn more about their illness and the latest treatments, and find social support with other young breast cancer patients is part of treating the whole patient, Ms. Broxson said.

Support programs

To address the concerns of these younger women, M. D. Anderson has developed a number of new initiatives. The Beth Sanders Moore Young Breast Cancer Survivors Program was created in January 2005 to provide educational resources for women under the age of 45 with breast cancer and to research the needs of these women. The program was a surprise 50th birthday present from Jess Moore to his wife, who was diagnosed with breast cancer when she was 45 years old, as a tribute to her courage in fighting her own breast cancer and her desire to educate others.

“For young women who may have more than half of their lives ahead of them, breast cancer causes a big detour in their lives,” said Ms. Moore. “There are so many unknown issues that affect them: whether they’ll be able to have children, the side effects of radiation and chemotherapy that may bring on early menopause, and how the illness will affect them psychologically.” Ms. Moore said she wants the Young Breast Cancer Survivors Program to provide these young women with the most recent medical information as well as allow survivors to share ideas about related issues such as mental health and nutrition.

The program will sponsor its first workshop for young breast cancer survivors as part of the Anderson Network’s “Living Fully With and Beyond Cancer” conference (http://www.mdanderson.org/departments/andersonnet and click the link to the conference) in September 2006. Topics will include nutrition and weight management during and after breast cancer, mindfulness techniques as a way to control stress and anxiety, and sexuality and loss of sexual desire after breast cancer.

In addition to providing patients with current information about the disease, the Young Breast Cancer Survivors Program will educate healthcare providers about the needs of breast cancer patients under the age of 45.

For more information on this topic or for questions about M. D. Anderson’s treatments, programs, or services, call askMDAnderson at (877) MDA-6789.

TOP

Home/Current Issue | Previous Issues | Articles by Topic | Patient Education
About Oncolog | Contact OncoLog
Sign Up for E-mail Alerts

©2008 The University of Texas M. D. Anderson Cancer Center
1515 Holcombe Blvd., Houston, TX 77030
1-877-MDA-6789 (USA) / 1-713-792-3245  
 Patient Referral    Legal Statements    Privacy Policy